Category Archives: Reasons, Plans and Goals

Do You Like IPAs? Here’s Why You Should

May 2 20017 ….. by Christopher Wolfe, OD, FAAO, Dipl. ABO  Read the full post here. 

Dr. Wolfe is the Chairman of the Board for EyeAssure, an Optometric Independent Physician Association and a wholly owned subsidiary of the Nebraska Optometric Association.

I used to think that IPAs were just an extremely hoppy brew originating from pale malts that I would drink last  (or give away… to others who liked them of course) when they were a part of a seasonal variety pack.  India Pale Ales are not something that my palate can tolerate.

 It wasn’t until about 3-4 years ago that I discovered IPA’s (Independent Physician Associations) were also a powerful tool that physicians can use to provide value to and collectively negotiate with, third party payers.  This is defiantly an IPA that I could love!

As a student and new graduate, I always asked (and heard others ask) why we couldn’t come together as a profession and negotiate collectively with insurance companies.  Every time this question was asked by me or someone else it was met with a quick “we can’t discuss those things within our associations, it is antitrust”.

While this answer was (and is) technically correct, it was never followed with the legally appropriate mechanisms that exist so that physicians CAN collectively negotiate.  I was never satisfied with the answer since I knew that there had to be some way that physicians who practice in large groups or within hospitals were negotiating their insurance contracts.  So, I continued to ask.

Fortunately, one day, I was discussing these frustrations with someone who had a lot of experience negotiating with insurance companies.  When I expressed to him that I had been informed that “we can’t discuss those things”, he simply smiled and said; “that is incorrect”.  “You just have to know HOW to legally come together as a profession so that you CAN negotiate collectively.” 

That day was the beginning of a long and exciting journey for our profession.  Someday I will describe the vision and process that the Nebraska Optometric Association went through in researching, developing and launching an Optometric IPA, but for now, I want to focus on the general functions of an IPA.

An IPA is a legal entity that unites physicians allowing them to negotiate insurance contracts.  IPAs do this by providing VALUE to those insurers which in turn will provide a reason for the payer to add beneficial provisions in the contract with the providers represented by the IPA. There are multiple types of IPAs and IPA classification determines what components of a contract can be negotiated (I will discuss this in Part 2 and 3).  

Part of the role that the IPA plays in controlling costs (for the payer) and improving the quality of care include:

  1. Deliver the contract to the provider once it has been negotiated

    • One of the costs of doing business for insurance companies is organizing a provider network.  This means that if there are 500 providers of one type (in this case ODs) then that insurance company has to disseminate contracts and communication to 500 different addresses, if an IPA acts as an intermediary then the insurance company can have 1 place to go for these types of contacts.

  2. Credentials providers

    • Similar to the above, if the IPA can credential providers in a manner that is acceptable to an insurance company then that is less work and cost that an insurance company has to spend on credentialing individual providers.

    • This is also a benefit for the physicians since every contract that is negotiated by the IPA would likely include the provision of accepting the IPAs credentialing, so there is no need to re-credential for every contract that is accepted by the physician.

    • Additionally, this allows a favorable intermediary (the IPA) to act on behalf of the providers in the case that there are questions that arise during credentialing.

  3. Implements utilization management (UM)

    • As I discussed in a prior post, payers look at a distribution of codes and procedures for outlier providers who utilize these codes at a level that deviates from the norm.  This can be a significant cost to the insurance company.  It can also be difficult for the insurance company to determine if the outlier is legitimate (as in the case of a provider who sees only complicated glaucoma patients compared to the general primary care optometrist) or an aggressive biller.

    • Since the IPA performs the UM they determine legitimate outliers versus aggressive billers.  I would much rather have an optometric committee evaluating my care than a professional auditor since other ODs will understand the care of patients better than non-clinicians.

The bottom line:……………….  read more here! 

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Cardboard Is God’s Prophet For Optometry

If you knew the future of your business was in jeopardy and how far away in time that change is, would you do something differently?

garbage-402295_640Last night I dreamed I had a temporary job working for a large optical store chain in NY City (I did when I graduated Optometry School).  When I got there all the equipment was so old it was useless.  The batteries in the instrument handles were rotting. The corporate staff who ran the labs was upstairs watching TV as they no longer made lenses in the USA. The lenses came from Alibaba Wholesale of China or were send as complete pairs to customers on line. No one really wasted time shopping in stores that were expensive, old fashioned, and filled with depressed employees.  I tried to get some equipment to do my exams with from some of the staff watching TV but they just laughed at me and said, just give them more plus, their old and that will work. Young people get eye exams on line, they never come here anymore.

This is not imagination. Nearly half the people in America are on some sort of government subsidy (welfare) because they no longer have jobs. Manufacturing Cities, IMG_8992.jpglike Detroit, Memphis, Milwaukee, etc., look like the dystopian nightmare scenes sci-fi paints on your TV screens!  Since it is not really Sci-fi, it has in truth become the neon light of the sounds of silence, that no one hears.  Is it the end of America?  I doubt it, but it is the beginning of a huge new revolution. A revolution where many things die and new ones are born, many win and many lose. Will you be a winner or loser? What have you planned and worked to become?  If the answer is, “I have no plan yet”  then you are planning on losing.

Where do you choose to be tomorrow?  Will you be one of the people that government is planning on giving a “standard basic salary to so that they may find some work to raise them up from that poverty level?  Or are you a disrupter who will use technology to make change, progress, money with pride?

You have a choice before you but not for long.  The choice is not too painful now but will be later. What takes out the pain now is that it is still time to have a fusion of technology and tradition. Later you will have to lose all you own as it will be worthless and then you must start from scratch.  Have you seen this? If you have not noticed it, is is all around you!

Notice the Malls that are closing, and department stores that are going out of business Debeverywhere!  Everything is moving online. You can now shop directly from China via Alibaba.  Cardboard recycling is the new prophet. It prophesies the death of traditional business. There is a torrent of cardboard needing recycling as packages become cheaper to deliver than driving to the store. Amazon is the new supply company that is taking over the world, just as a few companies did in the movie Rollerball.

Change is inevitable as stone and steel comes to life and human form turns to….. We shall see.  The robots are not coming they are here.  You still have time, though.

If you are an eye doctor you can be part of the transition not the destruction and recreation; it is lots less painful.  This requires the Fusion of online home technology and 

vinny

in office service technology.  If you combine your in office service with the online homebound service need and product delivery you can transition rather than die and find  job in rebirth, if you are lucky.

Right now there is one chance, work with Vinny Calderon, Aspire Health Solutions and deliver service no one else has been willing to do. If not you have one clear future, it is written on the subway walls and tenement halls……… and it echoes in the sounds of silence.

 

Note.... Vinny Calderon does not know I wrote this! ...

Janr Ssor, Author,  Founder MeetUps For Intellectual Discussion And Dreams (in progress)

 

Why Not To Join VS Until Next Year!


Build.Your.Dreams

BECAUSE YOUR HARD EARNED EMPOWERMENT MAY VANISH!

MONEY GOES A LONG WAY:  As the New York IPA rose in visibility and significance over a year ago,  Vision Source sought to claim our network as its own. To do this they offered Vinny Calderon and myself Financial reimbursement in terms of lower dues and growing benefits for each of the  new members we signed up. Both Vinny and I refused despite the excellent personal Financial opportunity.  We chose to discuss VS with the board  instead.  The board decided that we would keep the door open for the future but not give up all you have worked for and paid for to VS). VS wants to  see itself as the next OD network in NY.  If we fail they may be. If we fail,  That should however be your last resort because if they are your only network (ipa) then you have NO CONTROL just like being a VSP or EYEMED  service provider!

HOW VISION SOURCE CREATES “ENTHUSIASM”  Vision Source grows by giving HIDDEN (Secret) benefits to those who will enthusiastically promote them. When I joined VS,  five years ago, it was because of the Overwhelming excitement shared by Dr Farkas’ office team. It was also NOT a franchise at that time. Had I known they were being paid (with a discounted fee and bonuses for signups) to be excited, I would not likely have joined even for the great camaraderie of Barry Farkas, Susan Resnick and their team.  I did not ever lose money  in VS and VS does have some good proprietary products to offer.  However, When a single doc is paying out the usual franchise fees they should not expect any big profits!  If you pay 3% of your gross and your gross is near $800,000   $24,000  is what you pay VS!  (A first year discount helps but you have likely traded $$ for lost empowerment).

DIVIDE AND CONQUER: The  VS new new strategy  (Sine your board chooses not to sell our network to them)  is to “encourage” your membership by giving you a first year discount (money). The downside is to your future. They get you into their network, when your board voted NOT to join VS at this time, because it potentially diminishes the NYIOPA’s power to work for you!

Why not come along for the ride this year and be a winner with us!  There is power in unity!

 

 

Reality Lesson – ACO Participation not promised!

aco-accesKey Statements from the AOA regarding what optometrist need to know to seek continued access to medical patients under medicare and medicare advantage (ACOs). 

  • Medicare ACOs are not required to include optometrists or ophthalmologists.
  • If you come across a closed panel serving Medicare patients, then you’re looking at a Medicare Advantage plan, the Medicare version of managed care organizations (MCOs).
  • ACOs might not realize the benefits optometrists provide, so optometrists will need to market their services and demonstrate their value to ACOs.
  • For Medicare, optometrists need to actively demonstrate value. This means participating in the Physician Quality Reporting System (PQRS), electronic prescribing, exchanging health information, implementing EHRs, exchanging health information with local optometrists, and tracking your results through clinical data registries.
  • Here are some suggested steps for optometrists to take to prepare for ACO participation:
    • Participate in PQRS.
    • Meaningfully use EHRs.
    • Use eRx.
    • Plan to join AOA clinical data registry under development.
    • Exchange health information with other practitioners <== For discussion at Boun Amici’s Wed June 15th 
    • Follow AOA Evidence-Based Clinical Guidelines.
    • Use other AOA Excel Tools to grow and enhance your practice.

     

Put The HealthCare Puzzle Together -See The Picture!

  • Optometric visits capture at risk patients between ages 15 –> 45 that PCPS do not see!  We see them for blurred vision. We are the Entry point to health care that is critical before it gets costly.
  • Optometric geographical distribution and office hours, makes us the ideal easy place for patients to come to, not a big central medical office that MD’s are forming for efficiency.
  • Optometric contact with leadership provides access to contacting ACO leadership for entry points.
  • Optometric technology – makes it easy to diagnose systemic disease via retina photography, cheaply, quickly and efficiently.
  • Primary Care Optometry — providing referrals to OMDs is the most efficient use of OMD surgical skills
  • Forming a Cooperative team and Branding ourselves in NY State would likely make us a sought out entry point  for MD / OD healthcare partnerships. Requiring a paradigm shift:
    • Retina Imaging Being Routine
    • Standardized reporting to pcps
    • Referring at risk patients to PCPS for consultation.
    • Taking the initiative by dispensing educational materials
    • Educating patients in our offices (as Dr Hom Suggested)
    • Connecting patients with online dietary advice such as health letters written by leading physicians who promote diet and lifestyle changes
The resultant picture:
profitable-healthcare-logo_med_hr

Gain Entry To Medical Eyecare & Earn $50,000 More!

profits10 Years ago I earned nearly $50,000 in one year by providing medical optometry to my patients and I did not have to submit one insurance claim!  After that year my income continued to increase every year. In several areas of the USA, optometric leaders are working on plans, similar to mine,  to prove it is profitable for OD’s and MDs in ACOs (accountable care organizations) to be working together!  Why wait for some outside agency to tell you what to do while stealing your profits! You can earn an extra $50,000 now while working on qualifying for the upcoming medical plans on your own! There is no reason we should not be  qualifying by proving it works now!

 

AN ACTION PLAN:  Here is my recommended NYOIPA plan for keeping ALL OF US  in medical eyecare (ACOS), helping you earn the respect of the local medical community, while making you a aco-acceslot more than $50,000!

I recommend every NYOIPA doctor commit  to offering a $45.00 Retina Photography Screening for every patient that comes into their office (even one time for children).  I can show you how to implement this program easily enough; I have done it.  Each doctor should also commit to providing a simple fast check box report to the patient’s PCP, if anything systemic was found (this is becoming the standard of care now).

Establishing A Brand Name – The NY Optometric IPA:  Every doctor in the IPA,  who reports findings to local MDs should use the report above or one like it of their own creation.  As part of your report letterhead, every report form should state your NYOIPA membership clearly and include a small copy of our logo:

 NYOIPA.-LEGAL-LOGO

A New York Optometric IPA Member  

  

 

This is all there is too it!  

 

How To Earn $50,000 Extra This Year!

An Overview: 10 years ago I implemented a medical eye care  program and earned nearly Diabetic.retinopahty$50,000 in increased profits that first year.  I paid off my camera in 6 months.  In addition I kept adding to my optometric medical income, year after year, by practicing the best medical optometry I could.  We also developed  a greater relationship with medical doctors in the community that lead to medical doctors asking their patients to get an update from us before their next medical visit!  Are we not here to help our patients?  If so, why not do so and get paid?

Here is what I did to get started. I purchased a brand new Topcon Retina Camera.  I put it in the screening room and taught my techs how to use it.  Next I put a computer viewing station (software to display the images) in every exam room (we had two exam rooms).   Finally, I created a report format  (get this and make it yours and use it) that I could send to every medical doctor my patients might see and I began using it daily!  I educated my screening staff on what major diseases we could diagnose via high resolution retina photography  (we call it digital retina imaging) and I gave them a script to learn.  They were required to recite this script to all our patients and they were paid a commission for each patient who paid for the retina imaging.

Here is the essence of the script.   The script explained a special offer to each patient:  We told them that we could often diagnose the early signs of diabetes, hardening of the arteries, macular degeneration, glaucoma and more by retina imaging.  In addition, if we caught diabetes or hypertensive retinopathy, we could potentially help them avoid, strokes, heart attacks, diabetic vision loss and more. The screening would cost just $40 (we upped the fee since to $45) and we would give them a report for their records.

How I earned $50,000 extra the first year and took GREAT care of my patients!  Nearly 60% of my first years patients had the inexpensive screening done.  As you know, a huge number of patients were diagnosed with Hypertensive Retinopathy (stage II or more) and many diabetics were discovered. A good number of our patients who we referred to their PCPs (after we took time to educate them!),  made an effort and changed their lifestyle.  A few, who were totally stubborn, did nothing and  some had strokes,  lost vision or  even died prematurely!  This reinforced my commitment to see that my patients got the best care possible,  a retina imaging at least every other year if they were over 40!  At least we try to do this every year so that they are educated and reminded of what optometry means to them.

We Educated Our Patients Using The Internet (other doctors newsletters)  So It Did Not Take Much Time!  We follow up on all our patients with Educational Materials  (use this book free, I wrote it and made if free for everyone),  in the form of handouts and links to free online health letters.  Most patients made some effort to change their diet and lifestyle.  Even if it was just adding omega 3 oils to their diets.  Some cut carbs as I told them to do and lost over 100 LBS (one man did this in one year and has still kept it off 10 years later!).  Seeing them yearly and educating them by emailing them links to newsletters etc does work (of course not for everyone).  I was present at a meeting of alternative health care providers, last month,  and was honored to hear an RN share, that I saved her daughter’s life.  She related how I diagnosed her daugher (age 20) with stage II Nicking years earlier and got her to change her diet and lifestyle.  I would not have claimed that I had saved her life,  but she might be right.  What could be more rewarding?

The Bottom Line (other than great patient care!):  I was seeing nearly 2,500 patients a year 10 years ago.  If 60% paid  $45.00 for a screening (and I gave $5.00 to my techs),  this earns you $60,000 net.  Do the math:  2,500 x  0.6 =  1,500     1,500 X $40 =  $60,000 I did not quite make that much but you can see how you can do so pretty easily.   Most importantly you diagnose lots of disease you might not catch otherwise.  The patients also get a referral to their PCP and end up with great health care.  Your credibility soars with the patient and the local MDs.  Its a win, win, win!   Don’t forget too, that in addition, all the diagnosis you made from the screening require medical follow up.  This now allows you to add still better care for the patients and have insurance pay for those visits.   How often do you follow a diabetic?  How about a hypertensive with boxcarring?

Want references to help you understand more about your role in total patient care?   Here is how to cut the cost of health care and why you need to follow patients with hypertensive retinopathy.